About the presenter: Lynne W. Shields, Ph.D. CCC-SLP teaches at Fontbonne University in St. Louis, MO and serves as the program director for the graduate program in speech-language pathology. She teaches courses in fluency disorders, counseling and language disorders, and supervises in the on campus speech & language clinic. She holds specialty recognition in fluency disorders.

You can post Questions/comments about the following paper to the author before October 22, 2008.

Working Together to Make Therapy Work: Getting Others in on the Act

by Lynne Shields
from Missouri, USA

When working with someone who stutters, an important partnership exists between the speech-language pathologist (SLP) and the client, where both are exploring stuttering together, trying out management techniques, and problem solving the situations and issues that are important to the client. That partnership is very important to the therapeutic process. However, most of the person's day is outside of therapy, with family and friends, teachers or employers and coworkers. It is fairly common to find that one or more of these people have expectations of the person who stutters that may not be very realistic. A mother or father reports that their son or daughter never uses their therapy tools outside of therapy and expresses surprise that the child is not using a skill that has been demonstrated in the clinic setting. A teacher writes that the child isn't remembering to use his easy speech unless she tells him to do so. A spouse complains that her husband isn't remembering to use his therapy techniques at home.

One solution to this mismatch between expectations and the reality of stuttering for the client is to engage someone important to the client in the therapy process. In the case of a child, one or both parents can be involved in therapy in a way that helps the parents understand both the therapy tools that are being learned as well as the challenges of making behavioral changes. If the client is being asked to explore stuttering by using voluntary stuttering, mom and dad learn to do voluntary stuttering, too. If the client is learning how to use gentle voice onset or easy beginnings of words, then the parents also learn how to do this.

This process of including the family involves more than simply learning the specific management techniques; I want them to engage in the new behavior with the child outside of therapy. For example, if the child has decided to try voluntary stuttering when ordering ice cream, the parents can also do this while making their own order. This gives the child partners in learning new behaviors, someone, or several people, to work as a team with the child.

Having parents or others using the therapy tools whenever the child is using them supports the child in several ways. First, it provides a direct model of the behavior to the child in a setting outside of therapy and, second, it provides support in that the child is not the only person being expected to use the new skill in that setting. In addition to being supportive for the child, it also helps the parents understand what is involved in modifying speech. Mom and dad experience how difficult it really is to use voluntary stuttering or easy onsets for longer than a few utterances, especially when engaged in conversation. They also understand how funny it feels, motorically, to change speaking patterns or how strange it feels to talk differently in public. Having this kind of knowledge as a parent also provides support for the parent. Rather than simply being told about what is happening in therapy, they are gaining personal knowledge about the process of therapy.

Transfer of new skills outside of therapy is traditionally one of the most challenging aspects of therapy for stuttering. Having a family member, teacher or friend who is willing to engage more fully in the therapy process with the client can make therapy more meaningful to all concerned and can also assist in the transfer process.

You can post Questions/comments about the above paper to the author before October 22, 2008.